Daffos F, Forestier F, Capella-Pavlovsky M, Thulliez P, Aufrant C, Valenti D, Cox W L
Centre de Diagnostic Prénatal et de Foetologie, Hôpital Notre Dame de Bons Secours, Paris, France.
N Engl J Med. 1988 Feb 4;318(5):271-5. doi: 10.1056/NEJM198802043180502.
When infection with Toxoplasma gondii occurs during pregnancy, there is a risk that the parasite will cause severe congenital toxoplasmosis. We developed a method of diagnosing and treating congenital toxoplasmosis in utero. Diagnosis was based on the identification of maternal acute infection, followed by culture of fetal blood and amniotic fluid, testing of fetal blood for toxoplasma-specific IgM and nonspecific measures of infection, and ultrasound examination of the fetal brain. Treatment included the administration of antibiotics to all mothers with confirmed acute infection during pregnancy, with more intensive antibiotic treatment of those who had infected fetuses and who chose to continue the pregnancy. We report a prospective study of 746 documented cases of maternal toxoplasma infection, in which the infants were followed for at least three months. Infection was diagnosed antenatally in 39 of 42 fetuses. Twenty-four of the 39 pregnancies were terminated, and 15 were continued. All the mothers were treated with spiramycin throughout pregnancy; if fetal infection was demonstrated, pyrimethamine and either sulfadoxine or sulfadiazine were added to the regimen. Of the 15 fetuses with congenital toxoplasmosis who were carried to term, all but 2, who had chorioretinitis, remained clinically well during follow-up. We conclude that prenatal diagnosis of congenital toxoplasmosis is practical and that prenatal therapy in women who wish to continue their pregnancies reduces the severity of the manifestations of the disease.
孕期感染弓形虫时，存在寄生虫导致严重先天性弓形虫病的风险。我们研发了一种宫内诊断和治疗先天性弓形虫病的方法。诊断基于确定母亲的急性感染，随后对胎儿血液和羊水进行培养，检测胎儿血液中的弓形虫特异性IgM以及感染的非特异性指标，并对胎儿脑部进行超声检查。治疗包括对所有孕期确诊为急性感染的母亲使用抗生素，对那些胎儿感染且选择继续妊娠的母亲进行更强化的抗生素治疗。我们报告了一项对746例有记录的母亲弓形虫感染病例的前瞻性研究，其中对婴儿至少随访了三个月。42例胎儿中有39例在产前被诊断出感染。39例妊娠中有24例终止妊娠，15例继续妊娠。所有母亲在整个孕期都接受了螺旋霉素治疗；如果证实胎儿感染，则在治疗方案中添加乙胺嘧啶和磺胺多辛或磺胺嘧啶。在15例足月出生的先天性弓形虫病胎儿中，除2例患有脉络膜视网膜炎外，其余在随访期间临床状况良好。我们得出结论，先天性弓形虫病的产前诊断是可行的，并且对希望继续妊娠的女性进行产前治疗可降低该病表现的严重程度。
